Hemodynamic response in one session of strength exercise with and without electrostimulation in heart failure patients: a randomized controlled trial

Background: Studies have investigated the influence of neuromuscular electrostimulation on the exercise/muscle capacity of patients with heart failure (HF), but the hemodynamic overload has never been investigated. The aim of our study was to evaluate the heart rate (HR), systolic and diastolic blood pressures in one session of strength exercises with and without neuromuscular electrostimulation (quadriceps) in HF patients and in healthy subjects. Methods: Ten (50% male) HF patients and healthy subjects performed three sets of eight repetitions with and without neuromuscular electrostimulation randomly, with one week between sessions. Throughout, electromyography was performed to guarantee the electrostimulation was effective. The hemodynamic variables were measured at rest, again immediately after the end of each set of exercises, and during the recovery period. Results: Systolic and diastolic blood pressures did not change during each set of exercises among either the HF patients or the controls. Without electrostimulation: among the controls, the HR corresponding to the first (85 ± 13 bpm, p = 0.002), second (84 ± 10 bpm, p < 0.001), third (89 ± 17, p < 0.001) sets and recuperation (83 ± 16 bpm, p = 0.012) were different compared to the resting HR (77 bpm). Moreover, the recuperation was different to the third set (0.018). Among HF patients, the HR corresponding to the first (84 ± 9 bpm, p = 0.041) and third (84 ± 10 bpm, p = 0.036) sets were different compared to the resting HR (80 ± 7 bpm), but this increase of 4 bpm is clinically irrelevant to HF. With electrostimulation: among the controls, the HR corresponding to the third set (84 ± 9 bpm) was different compared to the resting HR (80 ± 7 bmp, p = 0.016). Among HF patients, there were no statistical differences between the sets. The procedure was well tolerated and no subjects reported muscle pain after 24 hours. Conclusions: One session of strength exercises with and without neuromuscular electrostimulation does not promote a hemodynamic overload in HF patients. (Cardiol J 2011; 18, 1: 39-46)

Dexmedetomidine Alters the Cardiovascular Response During Infra-Renal Aortic Cross-Clamping in Sevoflurane-Anesthetized Dogs

Some properties of the volatile anesthetics, such as vasodilatation and myocardial depression, combined with the sympathetic inhibition that alpha 2-agonists can produce may determine hemodynamic alterations during aortic, surgery. The interaction between dexmedetomidine (DEX), an alpha 2-agonist, and sevoflurane during aortic surgery is unknown. We studied the effects of DEX on hemodynamics and systemic oxygenation during aortic cross-clamping (Aox) and unclamping (UAox) in sevoflurane-anesthetized dogs Twenty dogs were. anesthetized with sevoflurane and were randomly assigned to two groups prior to Aox and UAox: control, n = 10, received saline infusion only, and DEX (1 mu g.kg(-1) load followed by 1 mu g.kg(-1).h(-1) infusion), n = 10. Hemodynamic and oxygenation variables were measured at baseline, after saline or DEX loading dose, 20 and 40 min after Aox, and 20 and 40 min after UAox. After DEX administration, heart rate, cardiac index l and systemic oxygen transport index (131021) were lower than in control group. Aox increased mean arterial pressure (MAP) and systemic vascular resistance index (SVRI) in both groups, but the effects were greater with DEX. Cl, heart rate, and DO(2)I were lower, while central venous pressure (CVP) and pulmonary artery occlusion pressure were higher in DEX compared to control. After UAox, MAP, CVP and SVRI were maintained higher in DEX in relation to control. We conclude that in sevoflurane-anesthetized dogs DEX alters the cardiovascular response during aortic surgery.

Uterine and luteal hemodynamic evaluation of the non pregnant mare

Background: Studies with Doppler ultrassonography started at the end of the 90s for the determination of physiological and pathological alterations in the reproductive tract of the mare. Uterine alterations caused by inflammation, response from seminal plasma infusion, hormonal variations during estrous and diestrus, pregnancy and action of various vasoactive factors influence on the vascular perfusion detected by Doppler ultrasound. The development of efficient methods for uterine quality evaluation is of big importance for field equine reproduction veterinarians, once uterine environment is responsible for pregnancy maintenance. Review: Nowadays, the most used methods of uterine evaluation are the mode B ultrassonography, cytology, culture and biopsy. Hemodynamic evaluation of the uterus can be done by spectral data collected from large vessels, as A. uterine and its ramifications, or from subjective or objective evaluations from endometrium, miometrium and mesometrium attachment, which provide data referent to local and specific alterations of the evaluated area. Alterations in uterine vascular perfusion has been detected during estrous cycle, during pregnancy and in cases of infusion of inflammatory substances. These alterations happen because of vasoactive substances that act in the uterus during these events, however, most of these vasoactive substances are probably not even known. Also, important hemodynamic alterations in old mares, as an increase in vascular resistance, have been described. This increase might result from fibrosis of the uterus and in women it is considered to be a cause of infertility. In mares, periglandular fibrosis of the endometrium is considered to be the major diagnosable cause of embryonic and fetal loss in older mares. For the CL, ovarian artery of the mare supplies the ovary as well as the oviduct and therefore can be used for evaluation of these areas. The CL evaluation can also be done by the percentage of luteum area with colored signals as an indicator of the extent of blood flow. The percentage of the CL area with colored signals is determined subjectively by images observations in real time and/or by a freezing Power Doppler cross-section image with the maximum number of color pixels taped and the total number of color pixels is assessed by a computer analysis system. Therefore, a high correlation between plasmatic progesterone and CL vascularization also allows the CL evalution by this technique. In a first report, CL circulation reached its maximum on D5, the progesterone concentration in peripheral blood increased until D7 and in a posterior report, maximum perfusion was achieved two days after the maximum progesterone concentration (D8). Blood flow reduced between D10-D14 some days before the plasma progesterone decrease and, during the luteolytic period (D15-D17), the decline in CL blood-flow area was greater than blood flow decrease. Conclusion: Doppler ultrassonography add knowledge about uterine viability and CL functionality can be easily used by veterinarians in the field. It is a noninvasive method that provides real time results. However, because of the short time studies in this area have been done, many other answers still need to be found until normal and pathological patterns will be established.